Pilot study using five methods to evaluate skin barrier function in healthy dogs and in dogs with atopic dermatitis

Preliminary evaluation of a commercial shampoo and fine bubble bathing in the treatment of canine atopic dermatitis: A single-blinded, randomised, controlled study

BACKGROUND

Fine bubble (FB) bathing has shown benefits on a mouse model of atopic dermatitis (AD). However, its efficacy in dogs with AD remains to be evaluated.

OBJECTIVE

This study aimed to assess the clinical effectiveness of FB bathing in dogs with AD.

ANIMALS

Seventeen dogs with AD whose clinical presentation showed a Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI-04) score of <40.

MATERIALS AND METHODS

The dogs were randomly assigned to either the FB bathing group or the shampoo group. The treatments were administered once a week as per the instructions, in a trial totalling 4 weeks. Evaluations were conducted on Day (D)0 and D28 to assess the outcomes of the trial. The severity of AD was measured using the CADESI-04 and the pruritus Visual Analog Scale (PVAS). The skin barrier function parameters, transepidermal water loss (TEWL) and stratum corneum hydration were measured before and after the treatment.

RESULTS

Both treatment groups demonstrated a decreasing trend in CADESI-04 scores, yet the FB group exhibited significant improvement in comparison to the shampoo group after 1 month of trial. There were no significant changes in PVAS scores in either group. No significant difference was found in skin barrier function parameters between the two treatments, although TEWL slightly decreased in the FB group and slightly increased in the shampoo group after treatment.

CONCLUSIONS AND CLINICAL RELEVANCE

These results suggested that FB treatment provides benefits for dogs with AD and offers an alternative topical treatment option with a lesser impact on skin barrier function compared to frequent shampooing.

Update on the skin barrier, cutaneous microbiome and host defence peptides in canine atopic dermatitis

BACKGROUND

Canine atopic dermatitis (AD) is a complex inflammatory skin disease associated with cutaneous microbiome, immunological and skin barrier alterations. This review summarises the current evidence on skin barrier defects and on cutaneous microbiome dysfunction in canine AD.

OBJECTIVE

To this aim, online citation databases, abstracts and proceedings from international meetings on skin barrier and cutaneous microbiome published between 2015 and 2023 were reviewed.

RESULTS

Since the last update on the pathogenesis of canine AD, published by the International Committee on Allergic Diseases of Animals in 2015, 49 articles have been published on skin barrier function, cutaneous/aural innate immunity and the cutaneous/aural microbiome in atopic dogs. Skin barrier dysfunction and cutaneous microbial dysbiosis are essential players in the pathogenesis of canine AD. It is still unclear if such alterations are primary or secondary to cutaneous inflammation, although some evidence supports their primary involvement in the pathogenesis of canine AD.

CONCLUSION AND CLINICAL RELEVANCE

Although many studies have been published since 2015, the understanding of the cutaneous host-microbe interaction is still unclear, as is the role that cutaneous dysbiosis plays in the development and/or worsening of canine AD. More studies are needed aiming to design new therapeutic approaches to restore the skin barrier, to increase and optimise the cutaneous natural defences, and to rebalance the cutaneous microbiome.

Skin Barrier Reinforcement Effect Assessment of a Spot-on Based on Natural Ingredients in a Dog Model of Tape Stripping

Simple Summary

Canine atopic dermatitis is a disease of dogs in which the skin becomes permeable. Part of treating canine atopic dermatitis involves restoring the skin barrier function; however, few effective therapeutic options exist. The goal of this study was to evaluate the effect of a spot-on containing fatty acids, ceramides and essential oils on two parameters to evaluate the skin barrier function of dogs. We found that this spot-on had a protective effect on the skin barrier function for both parameters. This study suggests that the investigated product may be useful as an adjunctive treatment for canine atopic dermatitis.

Abstract

Skin barrier restoration is an important part of atopic dermatitis therapy. We investigated the effect of a spot-on containing plant-based essential fatty acids and essential oils on skin barrier parameters in a dog model of acute skin barrier disruption, using five healthy beagle dogs maintained in a laboratory setting. Four test sites on the dorsum and a control site on the abdomen were defined on each dog. Transepidermal water loss (TEWL) and skin surface hydration (SSH) were measured before and after tape stripping on the first day and then for three consecutive days, over four consecutive weeks. The spot-on was applied at the end of each of the first three weeks. The increase in TEWL after tape stripping was reduced after the spot-on application and reached control values in Weeks 3 and 4. SSH after tape stripping was reduced in Week 4 compared with the baseline. Thus, the ATOP 7^® spot-on significantly reduced acute skin barrier impairment in a dog model. The use of this product should be further evaluated as a potential treatment for skin barrier defects such as canine atopic dermatitis.

Differences in Behavior between Normal and Atopic Keratinocytes in Culture: Pilot Studies

Skin barrier dysfunction is important in atopic dermatitis and can be secondary to inflammation. Observation of keratinocytes in culture may show intrinsic differences. TransEpithelial Electrical Resistance (TEER) measures epithelial permeability. We cultured normal and atopic keratinocytes and found that TEER of atopic keratinocytes was significantly lower (p < 0.0001) than that of normals. Atopic keratinocytes grew upwards, first creating isolated dome-like structures and later horizontally into a monolayer. At time of confluence (D0), atopic keratinocytes were more differentiated, with higher filaggrin gene expression than normals. No differences existed between groups for TJ proteins (claudin, occludin, and Zonula Occludens-1) on D0 and D6. On D6, claudin and occludin were higher than D0, in normal (p = 0.0296 and p = 0.0011) and atopic keratinocytes (p = 0.0348 and 0.0491). Immunofluorescent staining showed nuclear location of filaggrin on D0 and cytoplasmic on D6. ANOVA showed increased cell size from D0 to D6 in both groups (effect of time, p = 0.0076) but no differences between groups. Significant subject effect (p = 0.0022) was found, indicating that cell size was subject-dependent but not disease-dependent. No difference for continuity for TJ protein existed between groups. These observations suggest that decreased TEER in atopics is not linked to TJ differences but is possibly linked to different growth behavior.

Atopic Dermatitis in Domestic Animals: What Our Current Understanding Is and How This Applies to Clinical Practice

Atopic dermatitis is a clinical syndrome that affects both people and animals. Dogs closely mimic the complexity of the human skin disease, and much progress has been made in recent years in terms of our understanding of the role of skin impairment and the identification of new treatments. Cats and horses also develop atopic syndromes which include both cutaneous and respiratory signs, yet studies in these species are lagging. It is now recognized that atopic dermatitis is not a single disease but a multifaceted clinical syndrome with different pathways in various subgroups of patients. Appreciating this complexity is clinically relevant as we develop more targeted treatments which may work well in some patients but not in others. Different phenotypes of atopic dermatitis have been described in dogs, and it is possible that phenotypes related to breed and age may exist in other animals similar to how they are described in people. The awareness of different mechanisms of disease leads to the desire to correlate different phenotypes with specific biomarkers and responses to treatment. In this review, the current understanding and updated information on atopic syndrome in animals are described, highlighting opportunities for further studies in the future.

Advances in our understanding of canine atopic dermatitis

Canine atopic dermatitis (cAD) is a genetically inherited clinical syndrome that encompasses a diversity of mechanisms and can have a variety of triggers. Development of clinical disease is the result of genetic factors and environmental conditions, which shape the resulting immunological response. Clinical disease becomes evident once a threshold of inflammatory response is achieved. Skin barrier impairment plays a role in promoting cutaneous dysbiosis and increased allergen penetration. Keratinocytes shape the response of dendritic cells and subsequent lymphocytic response. Thymic stromal lymphopoietin is one of the links between the damaged skin barrier and the modulation of a T-helper (Th)2 response. It is still unclear whether mutations in skin barrier genes exist in atopic dogs, as they do in humans, or whether the observed alterations are purely secondary to inflammation. A dysregulated immune response with increased Th2, Th17 and CD4+ CD25+ regulatory T cells has been reported. A variety of cytokines [interleukin(IL)-31, IL-34, Macrophage migration inhibitory factor] are proposed as potential biomarkers and treatment targets because they are increased in the serum of atopic dogs when compared to controls, although a correlation between serum levels of these factors and severity of disease is not always present. The main issue with many published studies is that atopic dogs are always only compared to normal controls. Thus, it is unclear whether the changes that we find are truly a signature of cAD or merely a manifestation of nonspecific broad inflammatory responses. Studies considering comparison with other inflammatory diseases different from cAD are urgently needed to correctly identify what is specific to this complicated syndrome.

Preliminary evaluation of two bathing methods for the management of Malassezia overgrowth in dogs with atopic dermatitis

BACKGROUND

Antifungal shampoos are widely used for canine Malassezia dermatitis. Few studies have evaluated effective bathing methods for atopic dogs with Malassezia overgrowth.

OBJECTIVES

To evaluate the efficacy of an emollient bathing product (AFLOAT VET) and 2% miconazole/2% chlorhexidine shampoo (2% MIC/CHX) in atopic dogs, and to evaluate the influence on skin barrier function of both products in healthy dogs.

ANIMALS

Sixteen atopic dogs with secondary Malassezia overgrowth and 11 healthy dogs.

METHODS AND MATERIALS

This study was a randomized, single-blinded trial. The dogs were randomly treated with either emollient bathing or 2% MIC/CHX, twice weekly for four weeks. Clinical assessment used the Canine Atopic Dermatitis Extent and Severity Index, 4^th iteration (CADESI-04), pruritus Visual Analog Scale (pVAS), and cytological evaluation of yeast numbers at Day (D)0, D14 and D28. Skin barrier function was determined by measuring transepidermal water loss (TEWL) after a single bathing procedure with each product in the healthy dogs.

RESULTS

The pVAS scores and yeast counts were significantly reduced on D28 compared with D0 in both groups (P < 0.05). CADESI-04 was significantly decreased on D28 in the emollient bathing group (P = 0.003). There were no significant differences in each endpoint score between the groups. In healthy dogs, TEWL was significantly increased after bathing in both groups (P < 0.01).

CONCLUSION

An emollient bathing product can be effective for Malassezia overgrowth in dogs with atopic dermatitis. Bathing with shampoo products might affect skin barrier function even when using an emollient product.

The Association Between the Use of Oclacitinib and Antibacterial Therapy in Dogs With Allergic Dermatitis: A Retrospective Case-Control Study

Background: Canine allergic dermatitis, including atopic dermatitis, often requires antibacterial therapy for concurrent infections. Oclacitinib is indicated for treatment of pruritus associated with allergic dermatitis and the clinical manifestations of atopic dermatitis in dogs aged ≥12 months.

Hypothesis/Objectives: We aimed to determine if there was a quantitative difference in antibacterial use by dogs with allergic dermatitis receiving oclacitinib vs. other anti-pruritic therapies and before vs. after oclacitinib.

Animals: In this retrospective case-control study, cases (n = 58) included dogs suffering from allergic dermatitis aged ≥12 months receiving oclacitinib and controls (n = 205) were counterpart dogs treated with other anti-pruritic therapies.

Methods: Clinical histories of dogs with allergic dermatitis were collected from a small animal university hospital. Multivariable logistic regression models were developed adjusting for underlying skin or ear conditions to determine whether cases were prescribed fewer antibacterials than controls.

Results: The odds of systemic antibacterial usage were lower in cases vs. controls [odds ratio (OR): 0.29 (95% confidence interval 0.12–0.71); P = 0.007]. The odds of amoxycillin clavulanic acid usage (12.5–25 mg/kg orally every 12 h) was lower in cases vs. controls [OR: 0.08 (0.01–0.71); P = 0.024]. Topical antibacterial drug use was reduced overall; however, only the odds of neomycin use was lower in cases vs. controls [OR: 0.3 (0.1–0.89); P = 0.029]. Cases had higher odds of experiencing improvements in allergic dermatitis categories vs. controls [OR: 7.89 (3.26–19.13); P < 0.001].

Conclusions and Clinical Importance: Our results suggest that use of oclacitinib to treat allergic dermatitis in dogs is associated with less antibacterial use than other anti-pruritic therapies.

Clinical efficacy of spray-based heat-treated lactobacilli in canine atopic dermatitis: a preliminary, open-label, uncontrolled study

BACKGROUND

Canine atopic dermatitis (cAD) is a common inflammatory and pruritic skin disease, with various treatment options. The use of topical products containing natural ingredients has proven increasingly popular.

OBJECTIVE

To evaluate the effects of a spray solution containing heat-killed Lactobacillus rhamnosus and L. reuteri, on the clinical signs and cutaneous microbiota of atopic dogs.

ANIMALS

Ten privately owned, mildly affected, nonseasonally atopic dogs.

METHODS AND MATERIALS

The spray was applied to the ventrum every 24 h for 28 days. Clinical scores, skin barrier function and owner assessment were evaluated on day (D)0, D14, D28 and D42. The cutaneous microbiota was analysed on D0 and D28.

RESULTS

A reduction in the total clinical score was seen at each time point (D14, P = 0.03; D28, P = 0.04; D42, P = 0.001). A reduction in the regional clinical scores was seen after D28 (P = 0.01) and D42 (P = 0.003). A significant reduction in the pruritus score was seen on D42 (P = 0.01). A lower hydration value was seen on D28 (P = 0.02) and D42 (P = 0.02) on the pinnae. A good-to-excellent response and an easy-to-use administration was reported by owners. There were no significant changes in the cutaneous microbiota after 28 days.

CONCLUSIONS AND CLINICAL IMPORTANCE

There was a significant and rapid decrease in the clinical signs associated with cAD after use of the spray. Future larger, randomized, controlled studies are needed to confirm these results and to assess the effects on the cutaneous immunity and microflora of atopic dogs.

IgE sensitivity to Malassezia pachydermatis and mite allergens in dogs with atopic dermatitis

In this study, dogs with atopic dermatitis were separated into non-food-induced atopic dermatitis (NFIAD) group (n = 15) and food-induced atopic dermatitis (FIAD) group (n = 37) based on an elimination diet test. IgE reactivity for crude Malassezia pachydermatis (M. pachydermatis) and house dust mites (HDM) allergen extracts was investigated in the two groups using fluorometric enzyme-linked immunosorbent assay (ELISA) and intradermal skin test (IDST). Nine (60%) of the 15 dogs in NFIAD group and 6 (16%) of the 37 dogs in FIAD group showed specific IgE for M. pachydermatis (Mann-Whitney U-test, P < 0.01). By immunoblotting analysis, the pooled serum samples from dogs with IgE for M. pachydermatis showed IgE reactivity for 50 kDa protein of M. pachydermatis. Twelve (80%) of the 15 dogs in NFIAD group and 8 (22%) of the 37 dogs in FIAD group showed specific IgE for HDM (Mann-Whitney U-test, P < 0.01). In addition, the dogs in NFIAD group significantly show a positive IDST to M. pachydermatis and HDM extracts compared with the dogs in FIAD group. The results suggest that dogs with NFIAD are at increased risk of becoming sensitized to the normal commensal organism M. pachydermatis compared with dogs with FIAD, perhaps co-sensitization occurred due to an HDM protease antigen's, Der f 1 and/or Der p 1, proteolytic activity related epidermal skin barrier defects. Treatment to limit skin colonization may thus be especially important in NFIAD.

Development of a sprayable hydrogel formulation for the skin application of therapeutic antibodies

A formulation of an antibody with antibacterial properties for topical use on Staphylococcal skin infections was developed and characterized. The best formulation was obtained with 1.5% (w/v) sodium carboxymethylcellulose containing 10 mg/ml immunoglobulin. Spraying forces and rheological behavior were measured in order to characterize the hydrogel formulation. The percentage of antibody aggregates in gel as well as the antibody release, folding and target binding properties of the released antibody were analyzed to proof an acceptable shelf life and no significant changes in the activity of the antibody over time. No microbial contamination was observed in the chosen non-airless application container. Functional testing of the topical skin formulation was performed with an ex vivo biopsy culture model of dog skin. Histological analysis indicated efficacy in protection from Staphylococcus mediated skin damage and antibody delivery restricted to the epidermal surface. The results demonstrate that this hydrogel is suitable for cutaneous antibody applications in the medical field.